Peptik ülserli hastalarda ikinci basamak Helicobacter pylori eradikasyonunda bizmut bazlı 4'lü ve levofloksasin bazlı 3'lü tedavilerin karşılaştırılması: Tek merkezli pilot çalışma

Comparison of levofloxacin-based triple therapy with bismuth-based quadruple therapy for the second-line eradication of Helicobacter pylori in peptic ulcer disease: A single-center pilot study

Özet

Giriş ve Amaç: Bu randomize, prospektif çalışmada peptik ülserli Helicoba- cter pylori pozitif hastalarda, 2. basamak tedavide bizmut bazlı 4'lü tedavi ile levofloksasin bazlı 3'lü tedavilerin karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Mart 2014-Agustos 2015 tarihleri arasında peptik ülserli, 14 günlük klaritromisin bazlı klasik 3'lü eradikasyon sonrası Helicobacter py- lori pozitif 18 hasta ardışık olarak 2 gruba randomize edilerek çalışmaya alındı. Grup 1'e (n:10) bizmut bazlı 4'lü, grup 2'ye (n:8) levofloksasin bazlı 3'lü tedavi verildi. Her iki grupta lansoprazol (1x1) 12 haftaya tamamlandı. 15 gün ilaçsız dönem sonrası üre-nefes testi ve gaitada Helicobacter pylori antijen testi ile eradikasyon kontrolü yapıldı. Bulgular: Grup 1, %60 ka- dın, yaş ortalaması 45.7±8.8 yaş iken, grup 2, %25 kadın, yaş ortalaması 45.1±7.9 yaş idi. Tedavi sonrası grup 1'de üre-nefes testi ve gaitada Helicobacter pylori antijen testi 9 hastada negatif (eradikasyon oranı %90), grup 2'de 8 hastadan 3'ünde negatif (eradikasyon oranı %38) idi. İki grup arasında eradikasyon oranları açısından bizmut bazlı 4'lü tedavi lehine anlamlı farklılık saptandı (p

Abstract

Background and Aims: The aim of this prospective, randomized trial was to compare bismuth-based quadruple therapy with levofloxacin-based triple therapy for the second-line eradication of Helicobacter pylori in peptic ulcer disease. Materials and Methods: From March 2014 to August 2015, 18 Helicobacter pylori-positive patients with peptic ulcer disease were consec- utively randomized into two groups after 14 days of clarithromycin-based classic triple eradication. Group 1 (n=10) was given bismuth-based quadru- ple therapy and group 2 (n=8) was given levofloxacin-based triple thera- py. In both groups, lansoprazole (1x1) was completed in 12 weeks. After a 15-day washout period, a urea breath test and Helicobacter pylori stool antigen test were performed to monitor eradication. Results: Sixty percent of the patients in group 1 were female, mean age was 45.7±8.8 years, and in group 2, the mean age was 45.1±7.9 years . The urea breath test and Helicobacter pylori stool antigen test were negative in 9 patients in group 1 (eradication rate: 90%) and 3 patients in group 2 (eradication rate: 38%). There was a significant difference in the eradication rate between the two groups in favor of bismuth-based quadruple therapy (p < 0.005). Conclusion: We conclude that bismuth-based quadruple therapy is superior to levofloxacin-based triple therapy for the second-line eradica- tion of Helicobacter pylori in peptic ulcer disease. Although the number of patients was low in our study, this result might have been due to levofloxa- cin resistance. We propose that regional differences may have a role in sec- ond-line therapy, and more comprehensive studies including more patients are needed to address this issue.